Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual’s lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual’s behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan—which encourages residents to engage in the local society by participating in community places or groups that are referred to as ”Kayoi-no-ba”—and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.

Anterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for ACL injury, which typically uses a graft to replace the torn ligament in the knee that uses small incisions with minimally invasive surgery. The optimal knee functions following ACLR depend on rehabilitation processes before and after the surgery. Knee function is the ability of the knee to perform various types of functional movements like walking, squatting, running, jumping, and pivoting where patients expect to achieve maximum knee function or at least more than 80% of its initial condition before the injury to avoid being categorized as poor knee function after ACLR. Patients use patient-reported outcome measures to collect data on their health status and quality of life after ACLR. Post-traumatic osteoarthritis (PTOA) is a type of OA that manifests in local cartilage injury caused by chondrocyte death, and matrix dispersion occurs following a joint injury like ACL injury. Gender, time from injury to surgery, and graft type were considered as risk factors for poor knee function after ACLR, while overweight, meniscus tear, and cartilage defect as risk factors for PTOA. However, age is an internal risk factor for both poor knee function and PTOA following ACLR. This review suggests several strategies to prevent both conditions, including a pre-operative program, comprehensive rehabilitation, body weight control, and return to sport (RTS) consideration based on physical capacity, proper time, and psychological readiness.

Objectives: The coordination of glenohumeral (GH) and scapular movements is central to the injury prevention of baseball pitchers. However, there is no objective data establishing the direct relationship between pitching injuries and associated GH and scapular movements. Therefore, this study demonstrated the biomechanical differences in the scapular and GH movements during pitching between injury-prone pitchers and healthy college baseball pitchers. Methods: A total of 30 collegiate baseball pitchers were classified into two groups according to their injury status: injury-prone group (n = 15) and control group (n = 15). We obtained pitching motion data using three-dimensional motion analysis technique. Results: The horizontal abduction angles of the GH joint during cocking and acceleration phases were considerably greater in the injury-prone pitchers (19.0° at stride foot contact [SFC], −4.0° at maximum external rotation [MER], and −0.3° at ball release) than those in healthy controls (11.7° at SFC, −10.0° at MER, and −6.9° at ball release). Additionally, in the cocking phase, the amount of angular change in the scapular external rotation (ER) was significantly smaller in the injury-prone group than that in the control group (mean difference, −13.0). Conclusion: These results suggest that the injury-prone pitchers have less internal rotation of the scapula and a more horizontal abduction of the GH joint during the cocking and acceleration phases. Therefore, sports medicine practitioners may need to pay considerable attention to the coordination of scapular and GH horizontal movements during pitching for prevention of shoulder injuries.

Objective: This study aimed to clarify the association between hospital-acquired disability (HAD) and prognosis in older patients who underwent cardiac surgery. Methods: This single-center, retrospective, observational study included 141 patients aged ≥65 years who underwent cardiac surgery at our hospital from November 2016 to August 2021. The primary endpoint of this study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) within 2 years of hospital discharge. HAD was defined as a score of ≤5 on any one of the functional independence measure (FIM) subitems at discharge compared to preoperatively. Results: MACCE was observed in 16.3%, and the incidence of MACCE was significantly higher in the HAD group than that in the non-HAD group (12.1 vs. 34.5%, log-rank, p = 0.003). HAD was also significantly associated with the MACCE (hazard ratio [HD]: 2.575, 95% confidence interval [CI]: 1.001–9.655, p = 0.046). The incidence rate of HAD was 20.6%, with age (odds ratio [OR]: 1.260, 95% CI: 1.080–1.470, p = 0.004), preoperative short physical performance battery (SPPB) score (OR: 0.462, 95% CI: 0.301–0.708, p <0.001), and postoperative delirium (OR: 6.660, 95% CI: 1.480–30.000, p = 0.014) identified as significant factors. Conclusion: HAD is an independent predictor of MACCE in older patients who underwent cardiac surgery.

Objective: This preliminary study aimed to explore the reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults. Methods: Walking speed, stride length and time, cadence, walk ratio, and step width were calculated as spatiotemporal parameters of gait. Forward tilting of the trunk (FTT), hip flexion and extension, knee flexion and extension, and their laterality were measured as peak angles during one-gait cycle. The bootstrap method was conducted to estimate the 95% confidence interval (CI). Results: This study included 334 healthy older adults (255 women). The following gait parameters were estimated with 95%CI: walking speed (95%CI 1.21–1.30), cadence (95%CI 116.35–121.20), walk ratio (95%CI 0.0055–0.0060), step width (95%CI 0.15–0.17), FTT (95%CI 1.91–4.19), hip flexion (95%CI 28.54–31.01), hip extension (95%CI 19.30–22.27), knee extension (95%CI 0.09–0.14), laterality of hip flexion (95%CI 1.31–2.02), laterality of hip extension (95%CI 1.32–1.97), laterality of knee flexion (95%CI 3.41–4.77), and laterality of knee extension (95%CI 0.07–0.13) in men, and walking speed (95%CI 1.28–1.34), walk ratio (95%CI 0.0050–0.0054), FTT (95%CI 2.54–3.73), hip flexion (95%CI 32.80–34.28), laterality of hip flexion (95%CI 1.65–2.05), laterality of hip extension (95%CI 2.06–2.57), and laterality of knee flexion (95%CI 3.04–3.89) in women. Conclusion: This study suggested provisional reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults.